Steroid medication makes asthmatics depressed

People with severe asthma who rely on prednisone are more than three times more likely to be depressed than those with severe cases who don't use prednisone.

People with severe
asthma who rely on prednisone are more than three times more likely to be
depressed than those with severe cases who don't use prednisone and those with
mild to moderate asthma, according to a new study from The Netherlands.

Prednisone-dependent asthma patients "deserve"
screening for depression
and anxiety, the authors say, both to alleviate their suffering and
possibly improve their physical health through mental health
treatment. "There's a well-established connection with asthma, as well as
chronic illness in general and higher reports of depression than the general
population," Dr Rebecca Hashim told Reuters Health.

Hashim, an attending psychologist at Children's Hospital at
Montefiore Medical Centre in New York, was not involved in the study.

Prednisone is a steroid anti-inflammatory medication used to
treat asthma
attacks, often among people with severe symptoms.

Depression risks

Previous research has linked steroid
use to depression and other mood problems. And links in both directions
have been found between depression and the severity of asthma symptoms.

To examine depression risk among asthma patients, Dr Marijke
Amelink, from the department of Respiratory Medicine at the Academic Medical
Centre at the University of Amsterdam, and Dr Simone Hashimoto, of the
Institute of Psychiatry at Leiden University in Leiden, recruited 187 patients.

Among the patients, 67 had severe prednisone-dependent asthma
and 47 had severe non-prednisone dependent asthma. Another 73 patients had mild
to moderate asthma. People in the three groups were similar, although
prednisone-dependent patients tended to be older, with greater limitations in
their ability to breathe.

Depression and anxiety scores

All patients answered questions about depression and
anxiety, as well as questions designed to detect personality traits that could
contribute to their risk of mood issues.

The researchers found that patients with severe
prednisone-dependent asthma were 3.4 times more likely to be depressed than
non-prednisone dependent patients with severe asthma, and 3.5 times more likely
to be depressed than patients who had mild to moderate asthma.

The prednisone-dependent patients were also 2.5 times more
likely to have anxiety compared to patients with mild to moderate symptoms, but
there was no significant difference when compared to those with severe
non-prednisone dependent asthma.

The Dutch researchers didn't find any significant
differences in personality traits among the participants. In their report in
the journal Respiratory Medicine, the authors point out that
non-prednisone-dependent asthma patients had depression and anxiety scores that
were similar to those of the general public, while the prednisone-dependent patients
had scores similar to patients with other serious medical conditions.

Complex daily treatments

Hashim said the increased risk of depression might be due to
the stress of the treatment, rather than severity of illness. This would be
similar to other chronic illnesses, such as diabetes, that require complex
daily treatment regimens. "It's not really disease severity so much, but I
think what it does speak to is the level of maintenance required," she
said, "It reminds you of your illness all the time.

"Having long-term untreated depression or anxiety can
potentially lead to further illness, especially if it affects patients' ability
to take care of their health. "The more depressed you are, the less likely
you're going to be to be able to take care of these responsibilities," she
added.

Hashim said it's important for doctors to be screening for
depression, adding that caregivers and loved ones can go along on the office
visits to express their concerns to their doctors.

Ask the Expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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